Methods: 150 Baltimore children (5-17y) with persistent asthma were enrolled in a prospective cohort study. Questionnaires administered at baseline, 3, 6, 9, and 12 months captured symptoms, rescue medication use, asthma-related acute visits in the previous 3 months, and caregiver-reported asthma control. Controlled, uncontrolled, and poorly controlled asthma were defined based on days of symptoms, activity limitation, albuterol use, and nighttime awakenings in the past two weeks and FEV1/FVC . Relationships between caregiver-reported control and acute visits in the subsequent 3 months were analyzed using generalized estimating equations with a logit link function and a lagged caregiver-reported asthma control variable.
Results: 43.3% were female, 91.3% black, and 85.3% had public insurance. At baseline, 80% met NAEPP criteria for uncontrolled asthma, 20% had caregiver-reported uncontrolled asthma and 27.5% had an acute visit within the subsequent 3 months. In unadjusted models, caregiver-reported uncontrolled asthma was a predictor of an acute visit in the subsequent 3 months (OR [95% CI]: 2.4 [1.4-4.1], p = 0.001) and remained a predictor after adjusting for age, gender, insurance, NAEPP-based asthma control, and rhinitis (OR [95% CI]: 2.1 [1.2-3.6] p=0.01).
Conclusions: Caregiver-reported asthma control is a predictor of future acute asthma visits, independent of NAEPP guideline asthma control measures, suggesting that eliciting caregivers’ report of asthma control may be important in identifying children at high risk for future acute visits.